90% of therapy codes approved for telehealth are performed by therapy professionals not currently eligible for Medicare reimbursement

Washington, D.C. –– With the vast majority of Americans now under stay-at-home orders, the Alliance for Physical Therapy Quality and Innovation (APTQI) submitted comments to the Centers for Medicare & Medicaid Services (CMS) urging the agency to allow reimbursement for physical therapy services through telehealth appointments. The letter comes after physical therapists across the country shared stories of patients, who, abiding by government guidelines to stay home, are unable to receive medically necessary care—unless CMS expands access to telehealth services for additional specialty providers and their patients.

“We applaud the enormous efforts CMS and the Congress have made to expand patient access to telehealth services, however additional steps must be taken to enable therapy professionals to deliver the services Medicare has approved for telehealth,” said Nikesh Patel, Executive Director of APTQI. “A vast majority of therapy codes CMS approved for reimbursement in this week’s Interim Final Rule are performed by therapists – not physicians or other providers currently allowed to bill Medicare for telehealth services.”

According to the Interim Final Rule, “the majority of the [therapy] codes are furnished over 90 percent of the time by therapy professionals,” underscoring the importance of expanding reimbursement for therapy services to physical and occupational therapists who are not currently eligible for Medicare payment for telehealth services.

While voicing support for CMS’ goal to increase access to telehealth services through its recently issued Interim Final Rule, the letter emphasizes that physical therapy patients must not be left behind in these efforts. Specifically, the letter urges CMS to utilize its authority under Section 3703 of the Coronavirus AID, Relief, and Economic Security Act (CARES Act) to issue a blanket waiver expanding the range of providers eligible to deliver telehealth services under Medicare, including physical and occupational therapists. If the agency fails to issue such a waiver, beneficiaries will be limited to those therapy services delivered either in the home or office settings, locations that could expose vulnerable patient populations to increased risk of viral exposure and infection.

Having received numerous patient and provider stories over the last week, APTQI also used the letter to highlight a few stories that underscore the importance of telehealth expansion. One story comes from a 76-year-old woman from Virginia who suffers from osteoarthritis, degenerative joint disease, and lupus. Due to her age and underlying health conditions, she is socially isolated at home. Telehealth-based physical therapy services would be enormously beneficial, particularly since therapists can advise her on self-administered treatment approaches to address shoulder and back pain.

Another story comes out of Michigan, where a woman in her late 60s is suffering from post-operative pain following L4-L5 lumbar fusion surgery. Due to her asthma, she is frightened of contracting COVID-19. She would benefit enormously from telehealth-based physical therapy appointments that provide self-guided exercise and pain management treatments.

“These examples are among the growing number of stories we are hearing from providers and patients across the country. As this letter makes abundantly clear, these patients need a lifeline, and CMS can provide one by expanding access to telehealth-based physical therapy as permitted under the new CARES Act,” Patel concluded.